Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
Department of Psychology, University of South Florida, Tampa, FL, USA.
Ann Behav Med. 2022 Feb 11;56(2):137-145. doi: 10.1093/abm/kaab035.
Cognitive behavioral therapy for targeted-therapy related fatigue (CBT-TTF) has demonstrated preliminary efficacy in reducing fatigue in patients treated with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML).
The aim of the current analyses was to explore whether fatigue perpetuating factors (disturbed sleep/wake cycle, dysregulated activity patterns, maladaptive cognitions about fatigue and cancer, insufficient processing of cancer and treatment, inadequate social support and interactions, heightened fear of cancer progression) changed over time in patients receiving CBT-TTF, and whether the effect of CBT-TTF on fatigue was mediated by these factors.
Secondary data analyses were conducted from a pilot randomized controlled trial. Patients with CML treated with a TKI who reported moderate to severe fatigue were randomized 2:1 to CBT-TTF delivered via FaceTime for iPad or a waitlist control condition (WLC). Self-report measures of fatigue and fatigue perpetuating factors were obtained before randomization and post-intervention (i.e., approximately 18 weeks later). Mixed model and mediation analyses using bootstrap methods were used.
A total of 36 participants (CBT-TTF n = 22, WLC n = 14) who had baseline and 18-week follow-up data and attended >5 sessions for CBT-TTF were included. Participants randomized to CBT-TTF reported improvements in activity (mental, physical, social, p's ≤ .023) and cognitions (helplessness, catastrophizing, focusing on symptoms, self-efficacy, p's ≤ .003) compared to WLC. Mental activity, social activity, self-efficacy, helplessness, and focusing on symptoms, as well as sleep and insufficient processing (avoidance) mediated the relationship between treatment group and fatigue.
CBT-TTF appears to improve TKI-related fatigue in CML patients through changes in behavior (sleep, activity patterns) and cognitions about fatigue and cancer. A larger randomized controlled trial is warranted to confirm these findings.
针对靶向治疗相关疲劳的认知行为疗法（CBT-TTF）已初步证实可降低接受酪氨酸激酶抑制剂（TKI）治疗慢性髓性白血病（CML）患者的疲劳。
目前分析的目的是探讨接受 CBT-TTF 的患者的疲劳持续因素（睡眠/觉醒周期紊乱、活动模式失调、对疲劳和癌症的适应不良认知、癌症和治疗处理不足、社会支持和互动不足、对癌症进展的恐惧加剧）是否随时间而变化，以及 CBT-TTF 对疲劳的影响是否由这些因素介导。
对一项试点随机对照试验进行了二次数据分析。报告有中重度疲劳的接受 TKI 治疗的 CML 患者，按 2:1 随机分为通过 FaceTime for iPad 接受 CBT-TTF 或等候名单对照（WLC）。在随机分组前和干预后（即大约 18 周后）获得疲劳和疲劳持续因素的自我报告测量值。采用混合模型和中介分析。
共纳入 36 名参与者（CBT-TTF 组 n = 22，WLC 组 n = 14），这些参与者有基线和 18 周随访数据，并参加了>5 次 CBT-TTF 治疗。与 WLC 相比，接受 CBT-TTF 的患者报告的活动（心理、身体、社会，p 值≤.023）和认知（无助、灾难化、关注症状、自我效能，p 值≤.003）均有改善。心理活动、社会活动、自我效能、无助和关注症状以及睡眠和处理不足（回避），均介导了治疗组和疲劳之间的关系。
CBT-TTF 似乎通过改变与疲劳和癌症有关的行为（睡眠、活动模式）和认知，改善了 CML 患者的 TKI 相关疲劳。需要更大规模的随机对照试验来证实这些发现。
